Extradition is long, drawn out process and there are a lot of twists and turns the case could take before Knox could possibly be extradited to Italy.

Here's what could be next for Knox in a legal drama that has already dragged on for nearly seven years.

If the Italy's supreme court upholds Knox's conviction, Italian justice officials can then submit a formal request for her to be extradited to Italy under the country's 2010 bilateral treaty with the United States, said Bruce Zagaris, a Washington-based attorney who specializes in extradition cases. This is at the discretion of the Minister of Justice and may never happen.

If officials decide to seek her extradition, the next step is to submit the request to the U.S. Department of State and the Department of Justice's Office of International Affairs. This is where Knox has a fighting chance, Zagaris said.

If American officials deny Italy's request, Zagaris said they'll have to deal with "potential reciprocal and diplomatic effects."

"The U.S. often wants Italy to extradite all kinds of people, so if the U.S. refuses to even process the case, especially a case involving violence, that could have some adverse consequences for bilateral relaitons," Zagaris said.

What Happens if U.S. Officials Approve An Extradition Request

If U.S. officials determine the Italian case to extradite Knox falls under the treaty, they will send their findings to federal prosecutors in Seattle, where Knox lives and attends college.

Knox will then have the opportunity to defend herself against the ruling in a U.S. court.

"Even the court could take into consideration that there have been a number of irregularities in her case and as a result of the irregularities and the time she has spent detained, it would not be in the interest of justice," Zagaris said.

There's also the issue of double jeopardy. The decision today marks the third time a flip-flop verdict has been rendered in Knox's case.

In the American legal world, being retried for the same crime after being found innocent is "double jeopardy," which is outlawed in the U.S. judicial system.

American unease with double jeopardy could give Knox a "fighting chance" to appeal any extradition in a U.S. court, Christopher L. Blakesley, a professor of international law University of Nevada Las Vegas, told ABC News.com last year.

"There's room to fight extradition," Blakesley said, "and double jeopardy is the spot to fight on…. In the treaty, we functionally accept their system of justice, but it's up to a magistrate to decide whether" the double jeopardy clause of the Constitution was violated and if that trumps the treaty.

Knox's lawyers could also seek to have a prison sentence served in a U.S. prison instead of being sent back to Italy, Zagaris said.

If all else fails, Knox could be saved from extradition if Secretary of State John Kerry intervenes, according to Zagaris.

"She has raised a number of allegations about irregularities in terms of the ways she was apparently unfairly interrogated repeatedly [while in Italian custody] and so forth," Zagaris said.

"She definitely has some arguments because she has already gone through quite an ordeal."